A feasibility study carried out in the UK suggests that acupuncture can add benefit to standard care (SC) for back pain in pregnancy. The pilot randomised trial assigned 125 women with pregnancy-related back pain to one of three treatment arms: SC (self-management advice and physiotherapy), SC plus true acupuncture or SC plus non-penetrating acupuncture. Physiotherapists carried out acupuncture using six to 10 bilateral points selected from an agreed list, including both local paraspinal points and distal points. Between six and eight treatment sessions were offered to participants over a period of six weeks. Patient-reported outcomes (pain, function and quality of life) favoured the addition of acupuncture to SC for pregnancy-related back pain. Analysis of health economic outcomes showed that although SC plus true acupuncture had a higher total cost than SC alone, it also achieved higher QALY (quality-adjusted life-years) gains. No evidence of serious adverse effects on mothers or birth and neonatal outcomes from acupuncture was found.
Evaluating Acupuncture and Standard carE for pregnant women with Back pain (EASE Back): a feasibility study and pilot randomised trial. Health Technol Assess. 2016 Apr;20(33):1-236.

Electro-acupuncture (EA) may improve reproductive hormone levels in patients with diminished ovarian reserve (DOR), according to preliminary research from China. Twenty-one patients with DOR received EA over 12 weeks (five times a week for four weeks, followed by three times a week for eight weeks). Standardised EA treatment was provided using two alternating point prescriptions: A (Zhongliao BL-33) and B (Tianshu ST-25, Zigong M-CA-18 and Zhongji REN-4). Follicle-stimulating hormone (FSH) levels were observed to fall by almost half from baseline to week 12, and this decrease persisted until 12 weeks post-treatment, with no significant side effects. In addition, oestradiol and luteinising hormone (LH) levels, FSH/LH ratios and irritability scores were improved at weeks 12 and 24. Approximately 30% of patients reported subjective increases in menstrual volume after treatment.
Electroacupuncture for reproductive hormone levels in patients with diminished ovarian reserve: a prospective observational study. Acupunct Med. 2016 May 13. pii: acupmed-2015-011014.

Transcutaneous electrical acupoint stimulation (TEAS) can regulate hormone levels and improve clinical pregnancy rates in patients with decreased ovarian reserve (DOR) during in vitro fertilization (IVF) and embryo transfer. Chinese researchers divided 240 patients randomly into four groups: TEAS, placebo TEAS (pTEAS), hormone treatment (HT) and a control (CON) who received standard IVF treatment with no additional interventions. TEAS involved using a transcutaneous (needle-free) electrical acupoint stimulator at the following points: Guanyuan REN-4, Zhongji REN-3, Sanyinjiao SP-6, Zigong M-CA-18, Tianshu ST-25, Shenshu BL-23, Yaoyangguan DU-3 and Mingmen DU-4. Stimulation (2 Hz at 20–25 mA) lasted for 30 minutes and was given once a day for three menstrual cycles. After three monthly courses, treatment continued during the final ovulation cycle until the day of egg retrieval. In the TEAS and HT groups post-treatment, antral follicle count and anti-Müllerian hormone levels (both measures of ovarian reserve) were found to have increased, whereas levels of oestradiol and follicle-stimulating hormone (FSH) level, and FSH/LH ratio were significantly decreased (indicating an improvement in hormone levels). The average gonadotropin dosage and duration required for ovarian stimulation were lower in the TEAS and HT groups than in the CON and pTEAS groups, and were lower for TEAS compared with HT. The number of oocytes retrieved and average number of embryos transferred were also significantly higher in the TEAS and HT groups compared with the other two groups. Clinical pregnancy rates in the TEAS group were markedly higher than in the other three groups (42 per cent for TEAS versus 32 per cent for HT, 22 per cent for pTEAS and 21.5 per cent for CON).

Moxibustion at acupuncture point Zhiyin BL-67 can correct non-vertex presentation, reduce the number of caesarean sections performed and achieve cost savings for the healthcare system, compared with conventional treatment. Analysis by Spanish researchers showed that moxibustion prevents 8.92% of deliveries with non-vertex presentation compared with conventional treatment, resulting in an average cost saving of €107.11 per delivery (mainly due to the costs saved by avoiding the need for caesarean section). Analysis also showed an incremental cost per delivery ranging from €68 for moxibustion versus €640 for conventional treatment. (Cost effectiveness of using moxibustion to correct non-vertex presentation. Acupunct Med. 2015 Apr;33(2):136-41).

A review article by Australian authors has summarised the research evidence relating to the use of acupuncture for treating women’s reproductive disorders. The narrative literature covers both clinical research (assessing 204 documents) and experimental research (114 documents) on acupuncture’s mechanisms of action in relation to women’s health. The authors conclude that there is preliminary data indicating acupuncture may improve women’s menstrual health, as well as their ability to cope with delays in falling pregnant. They report that experimental data also indicate that acupuncture can influence female reproductive functioning, although the actual mechanisms involved have not yet been clarified. (Acupuncture and women’s health: an overview of the role of acupuncture and its clinical management in women’s reproductive health. Int J Womens Health. 2014 Mar 17;6:313-325). http: / / www.ncbi.nlm.nih.gov / pubmed /24669195

A Cochrane Database systematic review has concluded that current evidence supports acupuncture as a treatment for pelvic and back pain in pregnancy. The authors included 26 randomised trials examining 4093 pregnant women in their review. Moderate-quality evidence suggested that both acupuncture and exercise tailored to the stage of pregnancy can significantly reduce evening pelvic pain and lumbo-pelvic pain compared to usual care alone. In addition acupuncture was found to be significantly more effective than exercise for reducing evening pelvic pain, and was also more effective than physiotherapy at relieving evening lumbo-pelvic pain and disability and improving pain and function, although the effects were small. (Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev. 2013 Aug 1;8:CD001139).

A Cochrane Database systematic review has concluded that acupuncture and acupressure may have a role in reducing pain, increasing satisfaction with pain management and reducing use of pharmacological management for women in labour. Thirteen trials with data on 1986 women were included. Nine trials reported on acupuncture and four on acupressure. Less intense pain was found with acupuncture compared with no intervention. One trial showed increased satisfaction with pain relief compared with placebo. Reduced use of pharmacological analgesia was found in one trial of acupuncture compared with placebo and one compared with standard care. Fewer instrumental deliveries were found with acupuncture compared with standard care. Pain intensity was reduced with acupressure, compared with placebo and control and a combined control. Trials showed significant heterogeneity and all showed some risk of bias. (Acupuncture or acupressure for pain management in labour. Cochrane Database Syust Rev. 2011 Jul 6;(7):CD009232).

Acupuncture is an effective treatment for depression during pregnancy, according to a new American study. A hundred and fifty pregnant women with a diagnosis of major depression were randomised to receive 12 sessions of acupuncture consisting of a standardised point prescription specific for depression, or one of two active controls – control acupuncture or massage – over eight weeks. Women who received specific acupuncture experienced a greater rate of decrease in symptom severity compared with the combined controls or control acupuncture alone. They also showed a significantly greater response rate (63.0%) than the combined controls (44.3%) and control acupuncture alone (37.5%). Symptom reduction and response rates did not differ significantly between the controls. The authors conclude that the results achieved with acupuncture are similar to those achieved with standard depression treatments of similar duration. (Acupuncture for depression during pregnancy: a randomized controlled trial. Obstet Gynecol. 2010 Mar;115(3):511-20).
An update of a 2005 Cochrane systematic review concludes that there is currently insufficient evidence to recommend the use of acupuncture for people with depression, but notes that recommendations for practice cannot be made until further high quality research has been undertaken. Twenty-three new studies were added to the original pooled data, giving a total of 30 trials with 2812 participants in the meta-analysis. The authors concluded that there was insufficient evidence of a consistent beneficial effect from acupuncture compared with a wait list control or sham acupuncture control. Despite this, acupuncture performed well in comparisons against medication – the majority of trials found them to be equally effective in reducing the severity of depression. Two trials found acupuncture may have additional benefit when combined with medication compared with medication alone. A subgroup of participants with depression as a co-morbidity experienced a reduction in depression with manual acupuncture compared with SSRIs (three trials, 94 participants). (Acupuncture for depression. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD004046).
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Acupuncture may offer a drug-free alternative for treating depression in pregnant women, researchers have found. A study found that more pregnant women with depression benefited from acupuncture than those who had a sham treatment with needles or an ordinary massage. Two thirds who had the genuine acupuncture reported a significant improvement in their symptoms, compared with less than half of those who had the other treatments.

The study of 150 women with depression was conducted by a team at Stanford University in California and is published in the Journal of Obstetrics & Gynaecology. The approach may be particularly beneficial because depression in pregnancy can cause serious complications if untreated and yet women are reluctant to take drugs while carrying their child. Prof Rachel Manber, the lead author, said: “This standardised acupuncture protocol could be a viable treatment option for depression during pregnancy. “Because there is this concern about medication among pregnant women and their physicians, it’s important to find an alternative.”

Around 14 per cent of pregnant women may have depression and the condition is less well recognised than post-natal depression. It is thought the extra hormones during pregnancy may play a role in causing the condition or women may feel overwhelmed by the major changes they are undergoing.

The first prospective, randomised, single-blind, placebo-controlled study of the effect of acupuncture in infertile men with severe oligoasthenozoospermia has shown that acupuncture can improve sperm motility. The German study, involving 29 men compared TCM acupuncture with placebo acupuncture. A significantly higher percentage of motile sperm was found after real acupuncture. No effect of acupuncture on sperm concentration was observed. (A prospective randomized placebo-controlled study of the effect of acupuncture in infertile patients with severe oligoasthenozoospermia. Fertil Steril. 2009 Apr 24. [Epub ahead of print]).